Sleep Disorders

Why Do I Hold My Arms in the Air While Asleep

12/16/2011

Question:

I am 39 years-old. Since I can remember, I`ve occasionially woken up somewhere besides my bed, or saw signs that I had moved things in my sleep. I have the occasional night terror. I know that I snore. For the past few years, I`ve also started raising my arms straight up in the air and holding until gravity wins, according to my husband. He`s unfortunately been on the receiving end of my elbow. This all helps me understand why I never feel rested, but why do I do these things, and how can I make them stop? I take no prescription (or other) medications, so this all can`t be explained away as freakish side effects. Make me stop! Thank you!

Answer:

Your complaint is interesting in that you may have more than one sleep issue going on at present. You describe a history of a night terrors, snoring and sleep-related movements. When dealing with sleep disorders there is often quite a bit of overlap, and people may have more than one disorder at the same time.

During an episode of night terror, a person will appear awake and scared, and may exhibit rhythmic movements or shakes, but will have no recollection of the episode. The episode is very upsetting to the person who is witnessing it because the affected person is not consolable and does not respond to any comforting efforts. Night terrors are not related to scary dreams in particular, but may coincide with those kinds of dreams in the same person. There is no particular treatment needed for night terrors. A psychiatric evaluation may be of help in persons with history of traumatic events as in your case. Treatment of PTSD may result in decreasing frequency of night terrors in some individuals.

Snoring can be a sign of obstructive sleep apnea, where individuals periodically collapse their airway during sleep. This can result in brief “jerks” or movements in sleep during the efforts to breath or the arousals associated with restoring the normal breathing pattern.

You also mention erratic movements during sleep that result in hitting your bed partner. This is rarely a manifestation of night terror but it may represent a sign of another sleep disorder, known as a parasomnia, such as REM behavioral disorder (RBD). During normal rapid eye movement (REM) sleep, when most dreaming occurs, our voluntary muscles are paralyzed, which protects us from acting out our dreams. In people with RBD, this paralysis may not happen, and people may act out their dreams. These kinds of movements may also occur without any particular memory of associated dreams. REM behavior disorder needs to be evaluated by a specialized physician. This may include a careful review of the history of the problem and other medical problems, and may include performing a sleep study since many sleep disorders, certain medications and some sleep habits may cause REM behavior disorder to occur or to worsen.

Another group of sleep disorders that can result in movement in sleep are the Sleep Movement Disorders, which can be divided into 2 major types: Primary and Secondary. This depends on the lack or the presence of an underlying condition leading to the movements.

Primary sleep movement disorders have no clear underlying cause. These disorders can be further divided into several categories. The most common are:

Sleep walking

Confusional arousals

Dream-related movements

Rhythmic movement disorder

Periodic limb movements

Sleep walking and confusional arousals arise during the first half of the night, and people who have them don’t remember the movements. They are usually reported by bed partners (such as in your case). Dream-related movements occur during the second half of the night, but are usually related to dream content and are remembered by the sufferer. Rhythmic movement disorder occurs, most commonly, during childhood. It’s rare for it to persist into adulthood. It can take place at any time of the night. It’s mostly a self-soothing kind of movement and helps the waking person go back to sleep. The usual areas affected are the head, neck, legs, or the whole body. Periodic limb movements affect the lower extremities more often than the upper ones, and present as muscle jerks rather than organized complex sequence of behaviors.

Some of the causes of secondary sleep movement disorders are:

an underlying medical illness (such as seizures)

another sleep disorder (such as sleep apnea, particularly in snorers, like yourself)

an environmental stimulus (such as an uncomfortable bed, too much noise, or too much light in the bedroom)

the use of certain substances and medications (which does not apply to you)

It’s very difficult to give you a straight forward answer for your question without a personal discussion and probably a sleep study to rule out sleep apnea first. As you can see, there are a number of conditions to consider. I encourage you to visit a sleep specialist to start the evaluation process since this condition is affecting your sleep adversely where you find yourself un-refreshed in the morning.

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